Medicine

Writing Sub-test

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 Writing Task 1
This task is taken from www.occupationalenglishtest.org

OCCUPATIONAL ENGLISH TEST

WRITING SUB-TEST : MEDICINE
TIME ALLOWED : READING TIME: 5 MINUTES
WRITING TIME: 40 MINUTES

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 Writing Task 1 - Sample Response

OCCUPATIONAL ENGLISH TEST

WRITING SUB-TEST: MEDICINE
SAMPLE RESPONSE: LETTER OF REFERRAL

Dr Jason Roberts
Newtown Hospital
111 High Street
Newtown

(Today’s date)

Dear Dr Roberts

Re: Ms Anne Hall, DOB 19.09.1972

Thank you for seeing Ms Hall, a 44-year-old secondary school teacher, who is presenting with a two week
history of symptoms of dysphagia for solids, epigastric pain radiating posteriorly to T12 level, and concomi-
tant weight loss. The symptoms follow a constant course.

Ms Hall believes the problem commenced after an upper respiratory tract infection two weeks ago for which
she self-prescribed an over-the-counter Chinese herbal product with unknown ingredients. However, she has
also recently increased her coffee consumption and takes aspirin 2-3 times a month. She has a history of
dyspepsia (2012), and dermatitis for which she was prescribed oral and topical cortisone. There are no
apparent signs of anxiety. She has not smoked for the last 15 years. She drinks socially (mainly spirits),
has a family history of peptic ulcer disease and is allergic to codeine. Her BMI ia currently 28.2.

My provisional diagnosis is gastro-oesophageal reflux with possible stricture. I am referring Ms Hall to you
for the confirmation of the diagnosis. Consider performing an endoscopy if required. She has been asked to
reduce the consumption of coffee and alcohol and to stop using the OTC product. She is on pantaprazole 40
mg daily.

If you require any further information, please do not hesitate to contact me.

Yours sincerely

Doctor

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 Writing Task 2
This task is taken from www.occupationalenglishtest.org

OCCUPATIONAL ENGLISH TEST

WRITING SUB-TEST : MEDICINE
TIME ALLOWED : READING TIME: 5 MINUTES
WRITING TIME: 40 MINUTES

Read the case notes below and complete the writing task which follows.

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 Writing Task 2 - Sample Response

OCCUPATIONAL ENGLISH TEST

WRITING SUB-TEST: MEDICINE
SAMPLE RESPONSE: LETTER OF REFERRAL

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 Writing Task 3

OCCUPATIONAL ENGLISH TEST

WRITING SUB-TEST : MEDICINE
TIME ALLOWED : READING TIME: 5 MINUTES
WRITING TIME: 40 MINUTES

Read the case notes below and complete the writing task which follows.

Your patient, Robert Kent, has come to your clinic today with a worsening condition. The cardiologist he had
been seeing has retired recently.

Patient: Robert Kent (D.O.B.: 12/02/1956)

Address: 32 Melrose Park, Newtown

Marital Status: Married, 2 children (22, 25 yrs)

Family history: Brother died of CA of lung

Father died of MI at 60

Social background: Accountant - long hours at work, stressful job

Smoker (1 packet a day)

Medical history: Atrial fibrillation

Congestive Cardiac Failure
Hypertension
Inguinal Hernia repair
Osteoarthritis
Gout

Allergies: Pencillin, Sulphur based drugs

Medication: Candesartan 8 mg daily

Amilodipine 5 mg nocte
Apixaban - 5 mg BD
Lasix 40 mg mane
Allopurinol - 100 mg daily
Spironolactone - 25 mg
Panadol osteo - 665 mg TDS
Metoprolol - 25 mg BD

Presenting complaint: - SOBOE and chest pain

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Treatment Record

Subjective
Swollen ankles - bilateral
SOB even walking small distance
Feels like heart is pacing

Objective
oedema bilateral ankles
HR - 120
BP - 145/70
crackling on the base of both lungs on auscultation

Test results
U& E - all normal except Pot 5.7
Pro BnP - 14000
FBE - normal
High Sensitivity Troponin - 60 normal (0-15)
X-ray - marked cardiomyopathy, moderate pleural effusion (bilateral)

Assessment: Worsening CHF, ? IHD

Plan: Referral to a new cardiologist

Treatment for CHF and pleural effusion
Request for angiogram +- stent
R/V in 1 week post review by cardiologist

Using the information given in the case notes, write a letter of referral to Dr Steve Cehic, Cardiologist
at Rocky Cardiac Hospital, Newtown

In your answer:

· Expand the relevant notes into complete sentences

· Do NOT use note form
· Use letter format
The body of the letter should be approximately 180-200 words.

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 Writing Task 3 - Sample Response

OCCUPATIONAL ENGLISH TEST

WRITING SUB-TEST: MEDICINE
SAMPLE RESPONSE: LETTER OF REFERRAL

Dr Steve Cehic
Rocky Cardiac Hospital
Newtown

23 April 2019

Dear Dr Cehic,
Re: Robert Kent, DOB 12 February 1956

I am referring to you a patient of mine, Mr Robert Kent, 63 years old, for a detailed cardiac
assessment. He presented to my clinic with complaints of shortness of breath on exertion
and chest pain.
Robert developed bilateral oedema of ankles and a crackling noise was heard on
auscultation. He has an elevated heart rate of 120 and his BP was at 145/70. Robert has a
history of atrial fibrillation and congestive cardiac failure, which are managed by apixaban,
metoprolol and lasix. His blood pressure is managed with anti-hypertensives.
Robert was administered a few tests and the U&E test showed elevated potassium levels.
The proBnP level was at 14000 and the blood results were normal. Troponin levels were at
60. The chest x-ray shows cardiac myopathy and moderate pleural effusion.
I am concerned about his worsening CCF and a possible ischemic heart disease. His
bilateral pleural effusion needs attention as well. He may require an angiogram, and
perhaps stenting, based on his history and the elevated troponin levels. Please note that he
is allergic to Pencillin and sulphur based drugs.
Since Robert’s cardiac consultant has retired, I would be grateful if you could assess him
and recommend a treatment plan for his recovery. I will see him in a week after your review.
Yours sincerely,
Doctor

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 Writing Task 4

OCCUPATIONAL ENGLISH TEST

WRITING SUB-TEST : MEDICINE
TIME ALLOWED : READING TIME: 5 MINUTES
WRITING TIME: 40 MINUTES

Read the case notes below and complete the writing task which follows.

You are a doctor working in the general ward of Creekside Hospital. Hazel Logan is a patient
who was admitted in the Emergency Department and later transferred to your care.

Patient: Hazel Logan, (DOB: 12/02/1958)

Family: Husband - Benjamin Logan.
Lives in own home
Both retired
Children: Daughter – Kylie (25) lives with family in Sydney, Son – Fred (27) lives
in the UK, single, both rarely visit
Social History:
Occasional drinker, used to enjoy parties with friends
Stopped going out/ seeing friends over past few months
Recently withdrawn – husband attributes to possible mobility issues
Unable to do most household chores – rheumatoid arthritis prevents from moving
about freely
Husband does most of the cooking and cleaning, finds it difficult to cope
Past Medical History
rheumatoid arthritis (RA) (20 years)
hypertension (HT) (one year)
high cholesterol (dyslipidemia)
insomnia (2 years)
Recently found to be lethargic and losing weight.
Occasional numbness and tingling in extremities

Medication: Meloxicam (NSAID) capsules15 mg(RA)

Esidrex 25 mg (HT)
Niacin q.i.d. (cholesterol)
02/04/19
Admitted to emergency department:severe abdominal pain, vomiting and blood-stained
diarrhoea
Temperature 37°C
Diffuse tenderness at deep abdominal palpation
CAT scan

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 Mural thickening of entire right colon
Diagnosis: Colitis (inflammation of the colon) caused by NSAID abuse
Blood test
Intravenous antibiotic treatment with tazobactam started
Transferred to the general ward after 12 hours
04/04/19
Responding positively to antibiotics
Husband says, ‘noticed tablets for pain finishing faster than usual’
?overdose, patient denies at first, eventually admits dependence, reluctant to discuss
health issues
LFT [Liver Function Test] performed, elevated levels of SGPT/SGOT observed: NSAID
drug abuse established
Psychological assessment conducted
06/04/19
Meloxicam replaced with Rituximab (less addictive option)
Clinical psychologist conducts Initial inpatient counselling:
discuss excessive NSAID use
performs CBT (Cognitive Behavioural Therapy) session
needs to be continued with further sessions at rehab
Scheduled for discharge on 07/04/19
Dietician recommends diet plan – low fat (for cholesterol) , low salt (for HT) food –
discusses compliance with husband
Discharge plan
Referral to Prescription Drug Outpatient Rehabilitation clinic (Newcastle Rehabilitation
Centre, Creekside) for continued CBT, counselling and alternative therapies(once a
week) to commence from 10/04/19
Occupational Therapist to visit home and suggest modifications for improved mobility
and safety
Follow up with GP for management of HT, dyslipidemia& insomnia

Using the information in the case notes, write a letter to Ms Logan’s GP to inform them about her
condition and the treatment plan including the individual therapy at the rehabilitation centre. Address
the letter to Dr Jim Reid, Oakbarn General Practice, Creekside.
In your answer:
• Expand the relevant notes into complete sentences
• Do not use note form

• Use letter format

The body of the letter should be approximately 180-200 words.

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 Writing Task 4 - Sample Response

OCCUPATIONAL ENGLISH TEST

WRITING SUB-TEST: MEDICINE
SAMPLE RESPONSE: LETTER OF REFERRAL

Dr Jim Reid
Oakbarn General Practice
Creekside

7 April 2019

Dear Dr Reid,

Re: Hazel Logan, DOB: 12.02.1958

Your patient, Hazel Logan, has been recently admitted in the emergency department with
colitis. Investigations revealed increased levels of NSAIDs in her blood. A liver function test
showed elevated levels of SGOT/SGPT which has established an overuse of Meloxicam,
the pain medication she is prescribed for rheumatoid arthritis which she has had for twenty
years.

Hazel’s NSAID dependence had gone undetected although her husband had noticed ‘her
tablets for pain were finishing faster than usual’. He had also recently observed that she
was withdrawn but had linked this to her reduced mobility difficulties due to arthritic pain.
After initially denying that she was overusing her medication, Hazel accepted this and
underwent an initial inpatient counselling. The Meloxicam has been replaced with
Rituximab for its lower addictive properties.

Hazel is being discharged today and will require rehabilitation and individual therapy to
recover from her addiction. Newcastle Rehabilitation Centre, Creekside has been
requested to continue the cognitive behavioural therapy, counselling sessions and to start
with alternative therapies. The advice of an occupational therapist has also been
suggested. Kindly continue with the management of her hypertension, dyslipidemia and
insomnia.

Please contact me if you have any queries.

Yours sincerely,

Doctor

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 Writing Task 5

OCCUPATIONAL ENGLISH TEST

WRITING SUB-TEST : MEDICINE
TIME ALLOWED : READING TIME: 5 MINUTES
WRITING TIME: 40 MINUTES

Read the case notes below and complete the writing task which follows.

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 Writing Task 5 - Sample Response

OCCUPATIONAL ENGLISH TEST

WRITING SUB-TEST: MEDICINE
SAMPLE RESPONSE: LETTER OF REFERRAL

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 Writing Task 6

OCCUPATIONAL ENGLISH TEST

WRITING SUB-TEST : MEDICINE
TIME ALLOWED : READING TIME: 5 MINUTES
WRITING TIME: 40 MINUTES

Read the case notes below and complete the writing task which follows.

Notes:
Jamie Brown is a patient in your General Practice. He is a 5-year-old boy accompanied by
his mother.
20.12.14 5 yo boy, sore throat and husky voice, febrile and irritable.
O/E - T=39
- large, infected tonsils with exudate
- tender enlarged cervical nodes
Assessment Tonslilitis
Plan Pencillin v 250 mg qid for 7 days

28.01.15 Mum noticed that Jamie had brown urine 4 days ago. She says he is
tired and lethargic. No history of frequency, dysuria or trauma.
O/E ENT - tonsillar hypertrophy
BP 90/60
Urinanalysis - macroscopic heamaturia.
Assessment ? Post streptococcal nephritis
? UTI
Plan R/V in 2 days; drink plenty of fluids
Investigations - FBE + diff
Urea + creatinine
Electrolytes
- Asot titre
- MSU M/C/S + cell morphology

30.01.15 Patient still asymptomatic

O/E BP 110/90 Note ^ BP
Urinanalysis - macroscopic heameturia
Results - FBE normal
urea + creatinine sl. elevated
- ASOT elevated +++
- MSU 4 x10 # RBC of renal origin.
Assessment Poststreptococcal nephritis with early renal failure
Plan Refer to peadiatrician Dr F Goldman

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 Writing Task: .
Using the information in the case notes, write a referral to Dr F Goldman, 171 Victoria
Parade, East Melbourne

In your answer:

• Expand the relevant notes into complete sentences

• Do not use note form
• Use letter format
The body of the letter should be approximately 180-200 words.

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 Writing Task 7

OCCUPATIONAL ENGLISH TEST

WRITING SUB-TEST : MEDICINE
TIME ALLOWED : READING TIME: 5 MINUTES
WRITING TIME: 40 MINUTES

Read the case notes below and complete the writing task which follows.

Notes:

Hospital Ashford Hospital, Adelaide

Patient Details Clive Hawke, 52 Years old
Marital status: married
Wife (Maria Jennifer) to be contacted if there is any sort of emergency
Address: Arillon City Arcade 207 Murray Street, Adelaide
Admission Date 21/03/2010
Discharge Date 5/05/2010
Diagnosis Skin cancer – BCC (Basal Cell Carncinoma) (neck) Nodular
basal-cell carcinoma
Past Medical History No prior hospitalization, no history Medications
Social History Factory worker
Lives with wife
Habit of consuming liquor (for the past 25 years)
Cigarette Smoker
Dark skinned
Religion: Protestant
Medical Progress
23/03/2010 Skin biopsy (local anasthesia) is taken for pathological study
Pain reliever panadein forte 500mg
25/03/2010 Radiation therapy started
c/o vomiting twice
skin irritability and dryness
10/04/2010 Started on topical cream (5-fluorouracil cream)
5/05/2010 Perfectly well at the time of discharge
No complain of any pain

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Discharge Management Patient’s general condition to be monitored
Analgesics to be revised if necessary
Check for signs of future remissions
Topical cream to be discontinued 1/52

Writing Task: .
Using the information in the case notes, write a referral letter to the patient’s General
Practioner regarding the hospitalisation and post-discharge management. The patient is
registered with Dr Angela James, Murray Health Centre, Adelaide.

In your answer:

• Expand the relevant notes into complete sentences

• Do not use note form
• Use letter format
The body of the letter should be approximately 180-200 words.

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 Writing Task 8

OCCUPATIONAL ENGLISH TEST

WRITING SUB-TEST : MEDICINE
TIME ALLOWED : READING TIME: 5 MINUTES
WRITING TIME: 40 MINUTES

Read the case notes below and complete the writing task which follows.

Notes:

Mrs Larissa Zaneeta

38 year old marketing manager, married, one child (four-year-old boy).
Past history unremarkable. No medications
11/07/05
Complains of tiredness, difficulty sleeping for 2 months due to work stress
Plans another child in 12 months, currently on oral contraceptive pill (OCP)
O/E: Appears pale, tired and slightly restless
BP 140/80
No abnormal findings
Assessment: Stress-related anxiety
Plan: advised relaxation techniques, reduce working hours, prescribe sleeping
tablets tds

15/08/06
Stopped OCP 4 months earlier, still menstruating
Worried
Sleep still difficult, work stress unchanged, not possible to reduce hours
O/E: Tired-looking, slightly teary

Assessment: Work stress, growing anxiety failure to conceive

Plan: discussed nature of conception – takes time, patience

discussed frequency sexual intercourse
discussed methods – temperature / cycle
18/01/07
expressed anxiety re failure to conceive, says she’s “too old”
sleep still a problem

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O/E: crying, pale, fidgety
Vital signs / general exam NAD
Pelvic exam, pap smear
Assessment: as per previous consultation
Plan: 1-2 Valium b.d.
Suggested her to re-present next week accompanied by spouse.

25/01/07
Mr Zaneeta very supportive of having another child
No erectile dysfunction, libido normal
Mrs Zaneeta unchanged
O/E: Mr Zaneeta normal
Plan: Check Mr Zaneeta’s sperm count

02/02/07
Sperm count normal
Plan: Refer for specialist advice

Writing Task: .
Using the information in the case notes, write a letter of referral to Dr Elvira Sterinberg, a
gynaecologist at 123 Church St Richmond 3121.

In your answer:

• Expand the relevant notes into complete sentences

• Do not use note form
• Use letter format
The body of the letter should be approximately 180-200 words.

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 Writing Task 9

OCCUPATIONAL ENGLISH TEST

WRITING SUB-TEST : MEDICINE
TIME ALLOWED : READING TIME: 5 MINUTES
WRITING TIME: 40 MINUTES

Mr Zu is a patient in your general practice. Read the case notes below and complete the
writing task that follows.

Notes:
03/01/2013

Mr Jing ZU
72 yo man.

Past history Hypertension 18 years

Ischaemic heart disease 10 yrs
Acute Myocardial Infarction 1999
Congestive Cardiac Failure (CCF) 5 yrs

Family history unremarkable

Medications Lasix 40mg mane

Enalapril 10mg mane
Slow K TT bd
Nifedipine 10mg tds
Anginine T sl prn

Social History
Job: retired school teacher
Home: married
Activities: gardening
smoking: no

Subjective Angina on exertion – gardening, relief with rest and Anginine

Sleeps two pillows, no orthopnoea
Mild postural dizziness

Objective: Thin, looks well.

Pulse 84 reg, BP 160/90 lying, 145/80 standing
Jugular Venous Pressure (JVP) + 3 cm
Apex beat not displaced
S1 and S2 no extra sounds nor murmurs
Chest - Bilateral basal crepitations
Abdomen – normal
Ankles mild oedema, pulses present

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Assessment: Stable CCF, angina

Plan: Watchful monitoring

15/01/2013

Subjective: Ï dyspnoea, orthopnoea (sleeps on 4 pillows)

Ï ankle oedema
no chest pain

Objective: BP 140/90
JVP + 6 cm
Chest crepitations to mid zones
Heart S1 and S2
Ankles oedema to knees

Assessment: Deteriorating CCF ? cause

Plan: ECG, Ï Lasix 80 mg mane, R/V 2 days

19/01/2013

Subjective: Dyspnoea “feels a bit better”

Angina 10 min episode on mild exertion yesterday

Objective: JVP + 4 cm
Chest fewer crepitations to mid zones
ECG - ? ischaemic changes anterolaterally

Assessment: ischaemic heart disease

Plan: Referral Dr. George Isaacson, cardiologist, management of ischaemic heart

disease

Writing Task: .
Using the information in the case notes, write a letter of referral to Dr Isaacson, a cardiologist
at 45 Inkerman Street Caulfield 3162.

In your answer:

• Expand the relevant notes into complete sentences

• Do not use note form
• Use letter format
The body of the letter should be approximately 180-200 words.

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 Writing Task 10

OCCUPATIONAL ENGLISH TEST

WRITING SUB-TEST : MEDICINE
TIME ALLOWED : READING TIME: 5 MINUTES
WRITING TIME: 40 MINUTES

Ms Janet Bird is a patient in your general practice. Read the case notes below and
complete the writing task that follows.
Notes:

Ms Janet Bird
16 yo girl
Past history Unremarkable, no medications
Social History Attends local secondary school, Year 11, lives parents,
younger brother
11/11/07
Subjective Presented alone
Constipation 3 months, 1 X firm bowel action every 4-5 days
Diet includes 2 tablespoons bran in morning,
has tried laxatives
Otherwise well
Objective: Ht. 172 cms Wt. 52 kgs.
Pulse 72 reg, BP 100/50
Abdomen lax, no masses
Pt. Requested prescription for “strongest” laxative. Request refused.
Adviced vegetables, fibre and fluids.
28/12/07
Subjective: Presents with mother. Mother concerned Janet’s lack of
appetite and weight loss.
Family arguments about the situation.
Objective: Pale, thin. Wt. 47 kgs.
BP 100/60 lying and standing
Abdomen and urinalysis both unremarkable

Plan: Review Janet alone, Tests Full Blood Exam, Thyroid Function,
Liver Function

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05/01/08
Subjective: Janet complains parents are “over-reacting”. Feels her ideal weight
is 40 kgs.
Denies vomiting
Test results: normal
Assessment: Anorexia nervosa
Plan: Referral Dr. Suzanne O’Brien, psychiatrist

Writing Task: .
Using the information in the case notes, write a letter of referral to Dr O’Brien, a psychiatrist at
67 Sigmund Street Brighton 3186.

In your answer:

• Expand the relevant notes into complete sentences

• Do not use note form
• Use letter format
The body of the letter should be approximately 180-200 words.

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 Writing Task 11

OCCUPATIONAL ENGLISH TEST

WRITING SUB-TEST : MEDICINE
TIME ALLOWED : READING TIME: 5 MINUTES
WRITING TIME: 40 MINUTES

Read the case notes below and complete the writing task which follows.

Notes:
Mrs Trudy McHugh
Age: 38
Mother of 2
Breastfeeding 3 year old
27/1/02
5.30 yesterday: sudden onset of L lower abdominal pain
took 2 Valium, slept
Today: pain - still present - sharp and constant
worse sitting up, walking or bending
No urinary or bowel symptoms; no vomitting or nausea.
No loss of weight; no change of bowel habit.
Last menstrual period: November 2001
January 2002: vaginal bleeding & associated crampy abdominal pains
hospital o/patients tentative diagnosis: spontaneous abortion.
1 week before Xmas: episode of L lower abdominal pain.
History
Ovarian cystectomy & appendicectomy
Examination
Not distressed
BP 140/80;
Heart rate 96, regular
Very tender on light palpatation of L lower quadrant of
abdomen
Vague mass palpable
B-hCG to exclude pregnancy, full blood examination, ESR

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28/01/02
Pain there, but ‘easier’
No bowel motion since 26/1/02; passed hard stool with bright
blood on the outside.
29/01/02
Haemoglobin 9.3g/dl. Mild left shift.
Pain worse after eating tonight.
Moderately distressed. Abdomen tense.
Quiet bowel sounds.
Still no bowel action or flatus.
Temp 37.4
Assessment
early bowel obstruction due to - diverticulitis?
- carcinoma ?

Writing Task: .
Using the information in the case notes, write a letter of referral to Dr Nick Kontorinis, a
surgeon at Cravemar Medical Centre, Level 1 / 459 Toorak Road, Toorak, VIC 3142

In your answer:

• Expand the relevant notes into complete sentences

• Do not use note form
• Use letter format
The body of the letter should be approximately 180-200 words.

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 Writing Task 12

OCCUPATIONAL ENGLISH TEST

WRITING SUB-TEST : MEDICINE
TIME ALLOWED : READING TIME: 5 MINUTES
WRITING TIME: 40 MINUTES

Read the case notes below and complete the writing task which follows.
Notes:

Patient's name : Mrs. Lisa Bayliss

Date of Birth : 6th January, 1964
Social History : Married with 2 children, Heavy smoker, Drinks alcohol occasionally
Past Medical History : not relevant, no previous breast problem
Past Surgical History : Tubal ligation 8 years ago
Menstrual History: Menarche at the age of 11, Menstruation- normal flow,
periodregular, 3/28 cycle
Family History: No family history of breast disease
13/4/2009
Subjective: noticed lump in upper part of right breast 2 months ago, no change
in size during menstrual cycle, no discharge from nipple
Objective : pulse rate- 76/ min, BP-130/85, an ill-defined 1.5 cm lump in upper
quadrant of right breast, no lymph node enlargement, overlying skin-
normal, no evidence of attachment to surrounding structures, no
other abnormal findings on general examination
Assessment: Breast cancer or Fibroadenoma or cyst
Plan: Explain possible conditions & consequences, to undergo radiological
assessment (Mammogram) and Pathological assessment (Fine
needle aspiration or core biopsy )
20/4/2009
Subjective: extremely concerned about the possibility of cancer, difficult to sleep
at night, anxious, feeling low, sometimes irritated, pounding heart,
unable to cope even household chores, lack of concentration, breast
lump-no problem
Objective: PR 85/min, BP 140/90, Look anxious, sweaty, other examinations -
normal, Mammogram- normal, Ultrasound - confirmation of solid
lump, Cytological examination - malignant cells, Core biopsy under
local anaesthesia- adenocarcinoma
Assessment: Anxiety secondary to breast cancer ( adenocarcinoma )

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Plan: Break bad news, suggest to take further tests (blood tests, bone
scan , CT scans), outline different treatment options available such
as surgery, radiotherapy & chemotherapy, to refer to general
surgeon for operation
4/5/2009
Subjective; for regular follow-up, had local excision and axiallary clearance with
radiotherapy to residual right breast for local control
Objective; general condition- well , no evidence of metastases, hormone
receptor - negative
Assessment: post-operation recovery of grade 2 adencarcinoma
Plan: chemotherapy, regular reviews for cancer spread, to contact local
breast cancer foundation for further information
22/1/2010
Subjective: sudden onset of severe low back pain, suffering from mild back pain
4 weeks ago, no problem until 4 weeks ago, constant pain, keeping
her awake at night, exacerbated by movement, radiate down back
of left leg, 4 kg weight loss, the pain "got rid of her appetite"
Objective: pain distribution in front of thigh, inner aspect of thigh, knee & leg,
sensory loss in anterior aspect of thigh, absence of knee jerk
Assessment: Tumour spread to lumber spine
Plan: Bone scan, CT scan of chest & abdomen, radiotherapy to control
pain, refer to an oncologist for assessment & palliative care

Writing Task: .
Using the information in the case notes, write a letter of referral to Dr.Jacob Kumar
at the Royal Darwin Hospital, Rocklands Drive, Tiwi, PO Box 41326, Casuarina NT
0811.

In your answer:

• Expand the relevant notes into complete sentences

• Do not use note form
• Use letter format
The body of the letter should be approximately 180-200 words.

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 Writing Task 13

OCCUPATIONAL ENGLISH TEST

WRITING SUB-TEST : MEDICINE
TIME ALLOWED : READING TIME: 5 MINUTES
WRITING TIME: 40 MINUTES

Read the case notes below and complete the writing task which follows.

Notes:

Past history
Bernard Smith is a patient in your General Practice.

13.11.11
Subjective: 77 y.o. retired farmer. 2 months history of severe pain in R hip and
knee. 5 yrs of ‘trouble’ with R hip. Weight bears normally. Pain
increases over the day. No relief with Panadol.
Examination: Walks with limp. Temp 37 degrees Cel. BP 150/85. Decreased
internal rotation and flexion of R hip.
R knee normal.
Assessment: Osteoarthritis R hip
Plan: X-ray R hip - degenerative changes consistent with osteoarthritis.
X-ray R knee - normal.
Course of Indomethacin tabs 50 mg tds
12.1.12
Subjective: Flare up of R hip pain. Had ceased medication of own accord six
weeks ago.
Objective: Decreased range of movement in R hip, unable to weight bear.
Assessment: Exacerbation of osteoarthritis in R hip.
Plan: Recommence Indomethacin tabs 50 mg tds

18.1.12
Subjective: Complaining of dyspepsia after recommencing Indomethacin tablets.
Objective: Mild epigastric tenderness. Hip unchanged.
Assessment: Dyspepsia secondary to Indomethacin
Plan: Add Mylanta; change to Tilcotil 25 mg two tabs mane.

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16.2.12
Subjective: Little improvement in R hip, increasingly difficult to get around.
Dyspepsia settling.
Objective: Decreasing range movement in R hip.
Assessment: Osteoarthritis not responding to anti-inflammatory medication.
Plan: Refer to Orthopaedic surgeon for assessment and advice - possibly
needs hip replacement?

Writing Task: .
Using the information in the case notes, write a letter of referral to Dr Bob Dooley, Ortho-
paedic Surgeon at 34 Volturen St, Rewanden, VIC 4210

In your answer:

• Expand the relevant notes into complete sentences

• Do not use note form
• Use letter format
The body of the letter should be approximately 180-200 words.

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 Writing Task 14

OCCUPATIONAL ENGLISH TEST

WRITING SUB-TEST : MEDICINE
TIME ALLOWED : READING TIME: 5 MINUTES
WRITING TIME: 40 MINUTES

Read the case notes below and complete the writing task which follows.

Notes:

John Elvin is a 48-year-old patient in your General Practice

5/05/11
Subjective: Complaint of occasional mild central chest pain on exertion
Has mild asthma but otherwise previously well
Nil family history of cardiac disease
1 pack day smoker and drinks 10 standard drinks 5/7
Under significant stress with own business
Medications – seretide two puffs BD salbutamol two puffs prn
Allergies - Nil
Objective: Nil chest pain O/E
ECG NAD
Troponin level NAD
Assessment: Early stages of IHD
D/D - stress related chest pain
Alcohol dependence but not interested in changing
Plan: Check serum lipids
Refer for exercise stress test
Review in 1 week
12/5/11
Subjective: Still only very occasional chest pain on exertion
Has runny nose & pharyngitis at present with ‘!asthma symptoms
Attended stress test with very mild chest pain at high exercise load
Objective: Some very slight ischaemic changes present in exercise test
Mild bilateral wheeze present
Cholesterol mildly 
Assessment: Ischaemic heart disease/angina
Viral upper respiratory tract infection
Plan: Commence on lipitor, nitrates (imdur), aspirin and prn anginine
Educate anginine use
Review in 2/52
26/5/11
Subjective: Chest pain for the last week
Still c/o frequent mild wheeze
Often forgets to take seretide puffers because of ETOH

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 consumption
Objective: Mild bilateral wheeze still present
Assessment: Mild Asthma 2° to  compliance with medication
Alcohol dependence now affecting medication compliance
Plan: Emphasised importance of preventative anti-asthma meds
Recommended pt write a reminder for asthma and all
medications on his fridge.
Encouraged pt to use prn salbutamol until asthma improves
Offered ETOH dependence treatment pharmacotherapy- will
consider this.
1/6/11
Subjective: Passing by medical centre and c/o sudden onset crushing chest pain
on background of URTI and worsening asthma since last
Not relieved by anginine
Very audible wheeze
Examination: ECG – mild ST elevation in anterior leads. ST 120
Lungs – O/A moderate wheeze and mild bilateral crackles. SP O2
86% on R/A
Heart – Slight S3 sound +ve
Assessment: Likely anterior AMI; ? triggered by respiratory issues
Acute exacerbation of asthma 2° to URTI
? Mild APO
Plan: Paramedic transfer to ED
O2 15L via non-rebreather (pt isn’t CO2 retainer)
GTN patch applied
IV morphine 5mg given
Ipatropium Bromide 500ug given via nebuliser in view of tachycardia
Frusemide 40mg given

Writing Task: .
Using information provided in the case notes, write a referral letter to Dr Jeremy Barnett, the
Emergency Registrar on duty at Maroubra Hospital, Lakes Rd, Maroubra.

In your answer:

• Expand the relevant notes into complete sentences

• Do not use note form
• Use letter format
The body of the letter should be approximately 180-200 words.

39
 Writing Task 15

OCCUPATIONAL ENGLISH TEST

WRITING SUB-TEST : MEDICINE
TIME ALLOWED : READING TIME: 5 MINUTES
WRITING TIME: 40 MINUTES

Read the case notes below and complete the writing task which follows.

Notes:

Patient's name: Mrs. Rose Debham

Date of Birth: 4th July, 1989
Social History: recently married, no smoking or alcohol drinking
Past Medical History: previously fit, Migraine diag 5 mths ago - another GP
Medication History: Aspirin & Codeine & Metoclopramide to control migraine
Family history: mother- hypothroidism
2/12/2009
Subjective: feeling unwell for 3 months, intermittent fevers and sweats,
anorexia; Joints & muscles- ache , hands- painful & clumsy
with stiffness in mornings for about 1 hour
Objective: looks flushed, Temperature 38.6 degree C, Facial oedema -
present, pulse rate- 95 / min, BP- 110/65, Multiple aphthous-
like ulcers on buccal mucosa, heart & lungs - normal, spleen -
enlarged, hand joints - swollen and tender.
Assessment: possibility of autoimmune disease or infections
Plan: Explain the possibilities, confirmatory tests such as urinalysis,
blood tests, ESR, C reactive protein,blood culture, antibodies
screening, Ibuprofen 400 mg 3 times daily for symptomatic
control, review in a week's time
10/12/2009
Subjective: noticed slight improvement but still has pain in hand joints, no
fever, concerned about serious complications of autoimmune
diseases
Objective: swelling in hand joints -reduced, temp- normal, urinalysis-
trace of protein (0.3g/L), complete blood examination -
haemolysis & pancytopenia, ESR - 55mm/hour, C reactive
protein - 5 mg/L, Blood Culture - Negative, X ray (hand joints)
- soft tissue swelling & no erosion, CXR- normal, Antinuclear
& doulblestranded DNA antibodies- positive.
Assessment: Systemic lupus erythematosus

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Plan: general measures ( exercise, avoidance off UV light, screen),
continue NSAID (Non-Steroidal Anti-Inflammatory Drug),
hydroxycloroquine 200 mg 2 times daily, refer to specialist to
assess systemic involvements, regular reviews every month
20/1/2010
Subjective; regular check-up, all symptoms under control, able to cope
normal daily activities, arthritis,fever & lethargy -well
managed with current medication, expressed a strong desire
to conceive in near future, use condoms & spermicide for
contraception
Objective; all examinations - unremarkable
Assessment: well-controlled SLE
Plan: Continue current medication to prevent recurrence, Explain
the risks to mother & fetus, refer to consultant obstetrician
for advice prior to conception

Writing Task: .
Using the information in the case notes, write a letter of referral to Dr.Stephanie
Coleman, Consultant Obstetrician at the Royal Adelaide Hospital, North Terrace,
Adelaide SA 5000

In your answer:

• Expand the relevant notes into complete sentences

• Do not use note form
• Use letter format
The body of the letter should be approximately 180-200 words.

41
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